Discoveries

Does child CPR need to be revised?

By Matthew C. Wiencke

Braga shows off one of the manikins he uses to teach child CPR to residents.

Push hard. Push fast. Avoid interruptions. Allow full recoil. These simple steps—the CPR mantra that DMS's Matthew Braga, M.D., teaches his pediatric residents—can make all the difference in saving a child in cardiac arrest. Still, survival rates are very low for such children. They range from less than 5% for an out-of-hospital cardiac arrest to between 20% and 50% for an in-hospital arrest. So Braga, a pediatric critical care specialist, has been trying to improve the way child CPR (cardiopulmonary resuscitation) is conducted.

The American Heart Association recommends that when doing chest compressions on a child, the chest be depressed about one-third to one-half the depth of the chest. But, says Braga, "there's really no data to support [this recommendation]." So he and colleagues conducted one of the first studies to assess the recommendation.

Cutoff: They collected pediatric chest CT scans done for other reasons on 280 children of various ages. Using computer simulation, they calculated the children's residual internal chest depth—the space not taken up by bone or solid tissue—after a compression half the depth of their chest. They then figured what percentage of children would have a residual depth of 10mm (just under half an inch) or less. The researchers used 10mm as a cutoff point since an internal depth less than that, they believe, could injure internal organs—and in some children may not even be possible to achieve.

They discovered that 15 of 60 children between the ages of 3 months and 12 months "would theoretically have no residual internal depth," after a one-half-depth compression. And 59 of those 60, as well as 96 of 100 1- to 3-year-olds, would have a residual depth of less than 10mm. On the other hand, a one-third-depth compression on nearly all the children would be well above the 10mm mark.

The researchers concluded that one-third-depth compressions may be a better guideline. What is really needed to be sure, says Braga, are larger studies on actual pediatric patients receiving CPR. Those would be "the Holy Grail," he says, "but because they're infrequent and unpredictable, it's going to be difficult."